Can bringing TB services to patients find cases?

GUADALAJARA, Mexico – The thorny challenge of finding as many as 4 million patients with active TB thought to be missed each year will be a key theme of this week’s Union World Conference on Lung Health and was highlighted here today in the World Health Organization’s TB symposium. With the goal of “meeting patients where they are,” Christy Hanson of the Bill & Melinda Gates Foundation described a new methodology using data from existing country health systems to help find the missing cases.

A 13-country patient study showed 40 percent of people enter care in public facilities, 40 percent of people look to private health care providers for care, and 20 percent seek care in private, informal settings, Hanson said. This information provides a “good reflection of where people prefer to get care,” Hanson said, “and we should be aiming to provide TB care there.”

Moving then to look at the availability of TB diagnostics of all sorts in these various settings, Hanson noted they found a mismatch between where the patients are and where the diagnostics can be found. “Only 19 percent of patients who get their care in the public sector would encounter a TB diagnostic there,” she said, “ And we need to figure out how to get patient specimens to these diagnostics.”

Patient-centered care relies on understanding where patients prefer to get their care, and bringing services to those places, Hanson concluded. An operational guide based on this analysis for TB program managers and others will be released later this week.